Background: Low back pain (LBP) is prevalent, costly and disabling. A biopsychosocial treatment approach involving physical and cognitive behavioural therapy (CBT) is recommended for those with chronic LBP. It is not known if online psychological coaching tools might have a role in the secondary prevention of LBP related disability. To assess the effectiveness of an internet-delivered psychological program (MoodGYM) in addition to standard physical treatment in patients with chronic non-specific LBP at medium risk of ongoing disability.
Methods: A multisite randomized controlled trial was conducted with 108 participants (aged mean 50.4 ± 13.6 years) with chronic LBP attending one of six private physiotherapy or chiropractic clinics. Disability (Roland Morris Disability Questionnaire) and self-efficacy (Patient Self-Efficacy Questionnaire), were assessed at baseline, post-treatment (8-weeks) with follow-up at six- and twelve-months. Participants were randomized into either the intervention group, MoodGYM plus physical treatments, or the control group which received physical treatments alone.
Results: No statistically significant between group differences were observed for either disability at post-treatment (Effect size (standardised mean difference) 95% CI) RMD − 0.06 (− 0.45,0.31), 6-months RMD 0.01 (− 0.38,0.39) and 12-months − 0.20 (− 0.62,0.17) or self-efficacy at post-treatment PSEQ 0.06 (− 0.31,0.45), 6-months 0.02 (− 0.36,0.41) and 12-months 0.21 (− 0.16,0.63).
Conclusion: There was no additional benefit of an internet-delivered CBT program (MoodGYM) to physical treatments in those with chronic non-specific LBP at medium risk of ongoing disability measured at post-treatment, or at 6 and 12 months.
Trial registration: This trial was prospectively registered with Australian New Zealand Clinical Trials Registry Number (ACTRN) 12615000269538.
Author keywords: Chronic non-specific LBP — Disability — Self-efficacy — MoodGYM — Secondary psychosocial prevention — Chiropractic
Author affiliations: MJP, AL, PHF, MGM: Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia; SMR: Department of Health Sciences, Vrije Universiteit, Amsterdam, The Netherlands; MKJ: Discipline of Behavioural and Social Sciences in Health, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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